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J Wrist Surg 2018; 07(02): 101-108
DOI: 10.1055/s-0037-1608637
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Biomechanics of an Articulated Screw in Acute Scapholunate Ligament Disruption

Matthew E. Hiro
1   Division of Plastic Surgery, Bay Pines VA Medical Center, Bay Pines, Florida
,
Corey J. Schiffman
2   Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
,
Muturi G. Muriuki
3   Musculoskeletal Biomechanics Research Lab, Edward Hines Jr. VA Hospital, Hines, Illinois
,
Robert M. Havey
3   Musculoskeletal Biomechanics Research Lab, Edward Hines Jr. VA Hospital, Hines, Illinois
,
Leonard I. Voronov
3   Musculoskeletal Biomechanics Research Lab, Edward Hines Jr. VA Hospital, Hines, Illinois
,
Randy R. Bindra
4   Gold Coast University Hospital, Queensland, Australia
› Institutsangaben Funding This study was supported by an unconditional grant from Acumed LLC (Portland, OR).
Weitere Informationen

Publikationsverlauf

26. Mai 2017

30. September 2017

Publikationsdatum:
09. November 2017 (online)

    Lizenzen und Reprints

Abstract

Background An injury to the scapholunate interosseous ligament (SLIL) leads to instability in the scapholunate joint. Temporary fixation is used to protect the ligament during reconstruction or healing of the repair. Rigid screw fixation—by blocking relative physiological motion between the scaphoid and lunate—can lead to screw loosening, pullout, and fracture.

Purpose This study aims to evaluate changes in scaphoid and lunate kinematics following SLIL injury and the effectiveness of an articulating screw at restoring preinjury motion.

Materials and Methods The kinematics of the scaphoid and lunate were measured in 10 cadaver wrists through three motions driven by a motion simulator. The specimens were tested intact, immediately following SLIL injury, after subsequent cycling, and after fixation with a screw.

Results Significant changes in scaphoid and lunate motion occurred following SLIL injury. Postinjury cycling increased motion changes in flexion-extension and radial-ulnar deviation. The motion was not significantly different from the intact scapholunate joint after placement of the articulating screw.

Conclusion In agreement with other studies, sectioning of the SLIL led to significant kinematic changes of the scaphoid and lunate in all motions tested. Compared with intact scapholunate joint, no significant difference in kinematics was found after placement of the screw indicating a correction of some of the changes produced by SLIL transection. These findings suggest that the articulating screw may be effective for protecting a SLIL repair while allowing the physiological rotation to occur between the scaphoid and lunate.

Clinical Relevance A less rigid construct, such as the articulating screw, may allow earlier wrist rehabilitation with less screw pullout or failure.

Keywords

scapholunate interosseous ligament injury - scaphoid and lunate kinematics - screw fixation - flexion-extension - radial-ulnar deviation - dart-thrower's motion - biomechanics

Note

This study was performed at the Edward Hines Jr. VA Hospital and was approved by the R&D Committee of Edward Hines Jr. VA Hospital. No ethical review committee approval was required. This work was supported with resources and the use of facilities at the Edward Hines Jr. VA Hospital. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.


 

  • References

  • 1 Short WH, Werner FW, Green JK, Sutton LG, Brutus JP. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg Am 2007; 32 (03) 297-309
    CrossrefPubMedGoogle Scholar
  • 2 Waters MS, Werner FW, Haddad SF, McGrattan ML, Short WH. Biomechanical evaluation of scaphoid and lunate kinematics following selective sectioning of portions of the scapholunate interosseous ligament. J Hand Surg Am 2016; 41 (02) 208-213
    CrossrefPubMedGoogle Scholar
  • 3 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: Part II. J Hand Surg Am 2005; 30 (01) 24-34
    CrossrefPubMedGoogle Scholar
  • 4 Werner FW, Sutton LG, Allison MA, Gilula LA, Short WH, Wollstein R. Scaphoid and lunate translation in the intact wrist and following ligament resection: a cadaver study. J Hand Surg Am 2011; 36 (02) 291-298
    CrossrefPubMedGoogle Scholar
  • 5 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
    CrossrefPubMedGoogle Scholar
  • 6 O'Meeghan CJ, Stuart W, Mamo V, Stanley JK, Trail IA. The natural history of an untreated isolated scapholunate interosseus ligament injury. J Hand Surg [Br] 2003; 28 (04) 307-310
    Google Scholar
  • 7 Beredjiklian PK, Dugas J, Gerwin M. Primary repair of the scapholunate ligament. Tech Hand Up Extrem Surg 1998; 2 (04) 269-273
    CrossrefPubMedGoogle Scholar
  • 8 Saffar P, Sokolow C, Duclos L. Soft tissue stabilization in the management of chronic scapholunate instability without osteoarthritis. A 15-year series. Acta Orthop Belg 1999; 65 (04) 424-433
    PubMedGoogle Scholar
  • 9 Lavernia CJ, Cohen MS, Taleisnik J. Treatment of scapholunate dissociation by ligamentous repair and capsulodesis. J Hand Surg Am 1992; 17 (02) 354-359
    CrossrefPubMedGoogle Scholar
  • 10 Glickel SZ, Millender LH. Ligamentous reconstruction for chronic intercarpal instability. J Hand Surg Am 1984; 9 (04) 514-527
    CrossrefPubMedGoogle Scholar
  • 11 Weiss AP. Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft. J Hand Surg Am 1998; 23 (02) 205-215
    CrossrefPubMedGoogle Scholar
  • 12 Harvey EJ, Berger RA, Osterman AL, Fernandez DL, Weiss AP. Bone-tissue-bone repairs for scapholunate dissociation. J Hand Surg Am 2007; 32 (02) 256-264
    CrossrefPubMedGoogle Scholar
  • 13 Brunelli GA, Brunelli GR. A new surgical technique for carpal instability with scapho-lunar dislocation (Eleven cases). [in French]. Ann Chir Main Memb Super 1995; 14 (4-5): 207-213
    PubMedGoogle Scholar
  • 14 Nienstedt F. Treatment of static scapholunate instability with modified Brunelli tenodesis: results over 10 years. J Hand Surg Am 2013; 38 (05) 887-892
    CrossrefPubMedGoogle Scholar
  • 15 Zarkadas PC, Gropper PT, White NJ, Perey BH. A survey of the surgical management of acute and chronic scapholunate instability. J Hand Surg Am 2004; 29 (05) 848-857
    CrossrefPubMedGoogle Scholar
  • 16 Larson TB, Gaston RG, Chadderdon RC. The use of temporary screw augmentation for the treatment of scapholunate injuries. Tech Hand Up Extrem Surg 2012; 16 (03) 135-140
    CrossrefPubMedGoogle Scholar
  • 17 Filan SL, Herbert TJ. Herbert screw fixation for the treatment of scapholunate ligament rupture. Hand Surg 1998; 03 (01) 47-55
    CrossrefPubMedGoogle Scholar
  • 18 Opreanu RC, Baulch M, Katranji A. Reduction and maintenance of scapholunate dissociation using the TwinFix screw. Eplasty 2009; 9: e7
    PubMedGoogle Scholar
  • 19 Herbert TJ. Acute rotary dislocation of the scaphoid: a new technique of repair using Herbert screw fixation across the scapho-lunate joint. World J Surg 1991; 15 (04) 463-469
    CrossrefPubMedGoogle Scholar
  • 20 Cognet JM, Levadoux M, Martinache X. The use of screws in the treatment of scapholunate instability. J Hand Surg Eur Vol 2011; 36 (08) 690-693
    CrossrefPubMedGoogle Scholar
  • 21 Fok MW, Fernandez DL. Chronic scapholunate instability treated with temporary screw fixation. J Hand Surg Am 2015; 40 (04) 752-758
    CrossrefPubMedGoogle Scholar
  • 22 Manuel J, Moran SL. The diagnosis and treatment of scapholunate instability. Hand Clin 2010; 26 (01) 129-144
    CrossrefPubMedGoogle Scholar
  • 23 Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2012; 37 (10) 2175-2196
    CrossrefPubMedGoogle Scholar
  • 24 Garcia-Elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am 2006; 31 (01) 125-134
    CrossrefPubMedGoogle Scholar
  • 25 Short WH, Werner FW, Fortino MD, Palmer AK, Mann KA. A dynamic biomechanical study of scapholunate ligament sectioning. J Hand Surg Am 1995; 20 (06) 986-999
    CrossrefPubMedGoogle Scholar
  • 26 Werner FW, Short WH, Green JK. Changes in patterns of scaphoid and lunate motion during functional arcs of wrist motion induced by ligament division. J Hand Surg Am 2005; 30 (06) 1156-1160
    CrossrefPubMedGoogle Scholar
  • 27 Crisco JJ, Heard WM, Rich RR, Paller DJ, Wolfe SW. The mechanical axes of the wrist are oriented obliquely to the anatomical axes. J Bone Joint Surg Am 2011; 93 (02) 169-177
    CrossrefPubMedGoogle Scholar
  • 28 Brand PW, Beach RB, Thompson DE. Relative tension and potential excursion of muscles in the forearm and hand. J Hand Surg Am 1981; 6 (03) 209-219
    CrossrefPubMedGoogle Scholar
  • 29 Foumani M, Blankevoort L, Stekelenburg C. , et al. The effect of tendon loading on in-vitro carpal kinematics of the wrist joint. J Biomech 2010; 43 (09) 1799-1805
    CrossrefPubMedGoogle Scholar
  • 30 Gupta A. Change of carpal alignment under anaesthesia: role of physiological axial loading on carpus. Clin Biomech (Bristol, Avon) 2002; 17 (9-10): 660-665
    CrossrefPubMedGoogle Scholar
  • 31 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate. J Hand Surg Am 2002; 27 (06) 991-1002
    CrossrefPubMedGoogle Scholar
  • 32 Muriuki MG, Mohagheh-Motlagh A, Smolinski PJ, Miller MC. Elbow helical axes of motion are not the same in physiologic and kinetic joint simulators. J Biomech 2012; 45 (13) 2289-2292
    CrossrefPubMedGoogle Scholar
  • 33 Kobayashi M, Berger RA, Nagy L. , et al. Normal kinematics of carpal bones: a three-dimensional analysis of carpal bone motion relative to the radius. J Biomech 1997; 30 (08) 787-793
    CrossrefPubMedGoogle Scholar
  • 34 Tang JB, Ryu J, Omokawa S, Wearden S. Wrist kinetics after scapholunate dissociation: the effect of scapholunate interosseous ligament injury and persistent scapholunate gaps. J Orthop Res 2002; 20 (02) 215-221
    CrossrefPubMedGoogle Scholar
  • 35 Patterson RM, Williams L, Andersen CR, Koh S, Viegas SF. Carpal kinematics during simulated active and passive motion of the wrist. J Hand Surg Am 2007; 32 (07) 1013-1019
    CrossrefPubMedGoogle Scholar
  • 36 Garcia-Elias M. Understanding wrist mechanics: a long and winding road. J Wrist Surg 2013; 2 (01) 5-12
    PubMedGoogle Scholar